Limited Orbicularis Oculi Myectomy for Blepharospasm

Relevant Anatomy in Treating
Blepharospasm
Bobby S. Korn, M.D., Ph.D., F.A.C.S.
Associate Professor of Ophthalmology
Division of Ophthalmic Plastic and Reconstructive Surgery
UCSD Department of Ophthalmology
Shiley Eye Center, La Jolla CA
Presented at the Benign Essential
Blepharospasm Research Foundation
Symposium held on August 10, 2013 at
The University of California, San Diego
Goals for Today


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Review the muscles
responsible for facial
expression
Understand the role of
these muscles in
blepharospasm and
targets for treatment
Questions:
BKORN@UCSD.EDU
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Case Presentation

44 year old female

Referred from her primary care physician for a “droopy
eyelid” consultation

Pt has reportedly been unable to work for over 2 years

Complains of difficulty with driving and focusing

Referred to psychologist --> psychiatrist

Prescribed antidepressants

Seen my ophthalmologist and treated for dry eye

Seen multiple physicians and told her “nothing was wrong
with her and just go back to work.”
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Case Presentation
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Muscles of Facial Expression
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Facial Nerve

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Seventh cranial
nerve
Controls muscles
of facial
expression
Activation of this
nerve mediates
effects of
blepharospasm
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Why not eliminate facial nerve?

Facial nerve palsy
from parotid tumor
removal


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Lower lid ectropion
Eyelid retraction
Lagophthalmos
Tearing
Blurred vision
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Orbicularis Oculi

Most relevant to blepharospasm

Circular muscle that surrounds
eye

Major muscle that closes eyelid

Responsible for blink

Protects eye against trauma

Helps to pump tears through
lacrimal passages into nose

Located directed below our
eyelid skin
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Orbicularis Oculi
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Corrugator Supercilii Muscle



Pulls the eyebrow
down and medial,
inwards
Contributes to vertical
glablellar wrinkles
(frown lines)
Covered by thicker
skin and
subcutaneous tissue
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Procerus Muscle



Pulls down the skin
between eyebrows
Produces horizontal
wrinkles on bridge of
nose (bunny lines)
Covered by thicker
skin and
subcutaneous tissue
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Procerus Muscle



Pulls down the skin
between eyebrows
Produces horizontal
wrinkles on bridge of
nose (bunny lines)
Covered by thicker
skin and
subcutaneous tissue
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Corrugator and Procerus
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Zygomaticus Major and Minor
Muscles


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Raises the angle of
the mouth/cheek
when smiling
Creates dimples
Covered by skin and
cheek fat
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Zygomaticus Major and Minor
Muscles
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Levator Labii Superioris Muscle

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Lifts the upper lip
Dilates the nostril
Under the skin
transitioning between
the nose and cheek
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Orbicularis Oris Muscle
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Closes the mouth
Puckers the lips
Needed for sucking
on a straw or
whistling
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Orbicularis Oris Muscle
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
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Closes the mouth
Puckers the lips
Needed for sucking
on a straw or
whistling
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Orbicularis Oris Muscle
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Depressor Anguli Oris Muscle


Draws the corner of
the mouth downward
Deep to skin and
subcutaneous fat
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Depressor Anguli Oris Muscle
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Plastysma Muscle


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Aids to depress lower
jaw
Draws down the lower
lip and angle of the
mouth
Responsible for
“grimacing”
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Plastysma Muscle
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Meige’s Syndrome

Blepharospasm

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Abnormal twitching of the muscles of facial
expression, predominantly the orbicularis oculi,
corrugator and procerus
Oromandibular dystonia

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Focal dystonia affecting head and neck, including
lower face, jaw, tongue and larynx
Involuntary contractions involving the muscles of
mastication
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Muscles of Mastication
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Apraxia of Eyelid Opening

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Most often seen in conjunction with
blepharospasm
Inability to initiate eyelid lifting (levator
muscle)
See prominent brow elevation (frontalis
muscle) without effective eyelid opening
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Unable to open eyes >10 years
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Unable to open eyes >10 years
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Unable to open eyes >10 years
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Unable to open eyes >10 years
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3 months after myectomy
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Thank you!

“Our patients are our teachers.”
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